“Who…………Are…………..You?,” asks the caterpillar in Alice in Wonderland, repeatedly, as Alice attempts to affirm her identity, and finds little upon which to anchor the person she has known as herself. I think that must be what it is like to live with aphasia in the first few months or years. Everything one has learned about self, other, the world is in fuzzy focus, and there is little upon which to rely. Externals are loose, unfamiliar. It is like that otherworldly experience of catching sight of oneself in the mirror, and finding the person who stares back unfamiliar. What has transpired? Is it really me? How do I know?

Aphasia therapy can be a mirror in which the person with aphasia gradually comes to recognize himself, and to integrate an altered self. The aphasia therapist has a kind of advantage in not knowing the “before,” and in having an interest in the “after,” but is also at a disadvantage in not knowing the “who” that was before. I have had a startling few moments on occasion, seeing photos, or hearing audio tapes of clients in the pre-aphasia times. But my challenge is infinitely less than that of the client, who in time, must integrate the new “I”: the one with aphasia.

Identity development is a slow, steady process for all of us. What must it be like, in the sudden moment of stroke and aphasia, finding self changed radically, and reaching for what is real and defined in the personhood we have created? Terrifying, I think.

And how is it reforming a new identity, with bits of the old, and the images others have of us, old and new?